Postsurgery help a touchy topic

Lives are saved every day at Dunedin Hospital. But are the
surgeons' scalpels being blunted by a lack of help at home
afterwards, or are community expectations too high? Nigel
Benson and Eileen Goodwin report.

Call it serendipity.

Ten minutes after the Otago Daily Times visits Cliff
Rodger, the phone rings.

It is Healthcare New Zealand Dunedin manager Graeme Martin,
calling to reoffer the 86-year-old an hour of housework a
week, after his recent heart surgery.

Mr Martin squirms, like a decent man caught in an impossible
situation.

It is hard not to feel sympathy for him.

Mr Rodger sparked a huge response from ODT readers
this week after saying he felt abandoned by the Southern
District Health Board following his heart operation.

Mr Rodger has been regularly visited by a district nurse
since he left hospital and returned home - but complained
about what he sees as a lack of domestic help.

''The head surgeon said I'd get three hours of home help a
week, until I got back on my feet. But, now all they're
offering me is one hour a week,'' he fumes after the phone
call.

''They're a law unto themselves. It's wrong what they're
doing to the elderly.''

He said he declined the offer for one hour's housework a week
because it was inadequate and did not include washing clothes
and dishes.

The ODT was inundated with offers of help from readers
after highlighting his plight.

But whether Mr Rodger's is a lone case, or the tip of a wider
problem, is unclear. Anecdotal accounts of shortcomings in
home support had not been followed by specific complaints to
Age Concern Otago, the organisation's executive officer,
Susan Davidson, said this week.

''We are hearing rumblings in the community, but we have not
been approached by individual people.

''All the claims that we're hearing are second-hand.

''We don't know if it's a huge problem or if it's one or two
people.''

More co-ordination and communication at the point of hospital
discharge would probably help, she said.

''Hospitals have a single point of entry, but there is no
single point of exit. People exit hospital in all sorts of
different ways. But, discharge planning is not as robust as
it should be,'' she said.

Home help in Otago-Southland had a shake-up last year,
dislodging an array of mainly local providers in favour of
three North Island-based providers. The new system introduced
a so-called ''restorative'' model centred on abilities,
promoting independence and setting goals.

Ms Davidson broadly supports the new system, which was part
of a change encouraging older people to live at home for as
long as possible.

Help and support is increasingly provided informally through
community networks, rather than by the State. This raised
potential issues: it made sense to be cautious and vouch for
people through mutual friends, community groups, or church
networks. It was important the State supported the very frail
or those who were not ''joiners'' in the community.

''The system's in a great state of change - I'm optimistic
that it will be better in the end.''

Ms Davidson said expectations were probably unrealistic among
some older people because of memories of the
''cradle-to-grave welfare state''. Patients are assessed
postsurgery by a needs assessor, usually using computer
software called InterRai. The person is then referred to a
service provider - Healthcare New Zealand, Access, or Royal
District Nursing Service.

Access chief executive Graeme Titcombe denies the new system
is selling older people short.

What has changed is they are now accurately assessed for what
they can and cannot do. Assessment programme InterRai
pinpoints the need to the individual tasks required.

Before, carers tended to perform a similar range of tasks for
every client. The number of hours granted used to be
determined by the individual assessor, essentially a ''single
person's opinion'' of the situation. The national assessment
tool provided consistency. Mr Titcombe maintains there are
significant benefits for older people in keeping active and
independent.

They became ''more and more dependent'' if not performing
tasks they were capable of doing. It was especially important
for those recently discharged from hospital, and the new
system was an opportunity for them to recover more quickly
from their hospital stay, Mr Titcombe says.

He says expectations need to change in some quarters.

''With some people there is an expectation of some services
that are just not provided or funded by a DHB.

''We know that there are expectations from some clients which
are above and beyond what you would normally get from any DHB
in the country. And that often leads to misunderstandings and
dissatisfaction.''

Asked how older people could get these tasks performed, she
says she does not know. Common tasks provided include
cleaning kitchens, bathrooms, floors, or making beds.

The board has to allocate resources to those most in need -
there will always be ''unmet need'', she says.

''We are very much aware that we have an increasing elderly
population, and we've only got limited resources, and we need
to focus those resources ...''

What the new system does ensure is the fairest possible
spread of available resources, Mrs Boardman said.

Assessments take account of whether people have family and
friends living close who can help.

Last week, the Auditor-general issued a progress report on
the sector assessing work done implementing recommendations
in a 2011 performance audit.

The audit had said there was too much variation between
health boards, and called for better data collection,
introduction of a minimum standard of service quality,
development of a complaints system, better training and
supervision for carers.

In the update this month, the Auditor-general said there had
been progress in some areas but not in others. An evaluation
of the InterRai tool was delayed, and there was insufficient
data collection.

Health boards had resisted minimum training and supervision
levels for carers because of how much this would cost, and it
was unclear when the requirement would be included in service
contracts, the update said.

However, because of success implementing a new minimum
standard of service quality, training and supervision had
experienced improvement.

Home support
Number of those aged 65 and over is expected to double
between 2011 and 2036.
• Ageing population means keeping more people in their
homes.
• Home-based support is cheaper than residential care.
• Health boards spent $263 million on more than 10 million
hours home support for about 75,000 people in 2012-13.
• New system promotes independence and older people doing
more of their own housework.

The goverments of the day promised to fully fund community
rehabilitation when they began ejecting people from hospitals
and residential care facilities. Considering they are by the
own admission saving about $1000 a day by having people at
home the limited assistance given by Winz and funded home
help is a joke.
If it wasn't for the Red Cross supplying me with transport
(unfunded by the goverment) I would only be doing a quarter
of the rehab I am recovering from a stroke. This is because
the Winz disability allowance is capped at $69 per week and
after medicines, doctors etc there is little left. There
would not be enough for transport to more than one rehab
appointment.
if the government had their way I and many others for the
sake of a few extra dollars a week would be on the benefit
for months (in my case about 18months) more than needed. They
save several grand a week having me at home barely able to
pay bills and eat, but only contribute a generously estimated
$150 in home help and disability allowance and invalid's
benefit which after paying rent, power and phone/net leaves
me $45-50 a week for food. Thanks to the Red Cross i get to
do 25-30 hours of rehab a week instead of the 6-8 I would
otherwise be able to afford under current funding.
It's obvious this system is more about saving money in the
short term than rehab and getting people back into work.
[Abridged]

No, he is not an isolated case. When I had my hip replacement
in December last year I rang all the departments and none of
them knew where I could get home help. The hospital refered
me to the SDHB, who refered me to the the hospital who
suggested the doctor, who said there was nothing he could do.
I ended up hiring a cleaner for two hours a week at $15 per
hour. Eventually after the operation someone from Mercy asked
whether I would like 1 hour a week from somewhere but I had
already hired my cleaner in preparation for coming home from
hospital. What a confusing debarcle.
I refused that belated help as he has. One hour a week is
only long enough to say hello and tell them what needs doing.
You might then get the washing up done and the bath rinsed
out but that's about all. Disgusting!